No abstract available.
Female ; Pregnancy ; Pregnancy, Abdominal*

PURPOSE: To investigate the immunologic effect of the gasless laparoscopic procedure, we compared it with an immunologically effective, gas insuffulated (pneumoperitoneal) laparoscopic procedure. METHODS: The temporal immune responses in two similar groups of patients randomized to gas vs gasless laparo scopic cholecystectomy were analyzed. The patients were matched by age, weight, and operation time. Immune parameters, including serum white blood cell count and TNF-alpha, INF-gamma, IL-6, IL-8, cortisol and ESR levels, were assessed preoperatively and on postoperative days 1 and 3 between the two groups. Also during the operations, cytokines were checked in cultured peritoneal macrophages. RESULTS: The results were as follows: 1) Serum cortisol and ESR levels were not statistically different between the two groups. White blood cell counts were also not statistically different. 2) The preoperative and postoperative day 1 and days 3 serum TNF-alpha, INF-gamma, IL-6, and IL-8 levels in the two group were not statistically different. However, an immediate decrease cytokine levels was significant in both groups after postoperative day 1. 3) Especially cytokine levels were more increased in cultured peritoneal macro phages than in serum, but difference between the two groups was not statistically significant. CONCLUSION: From our results the beneficial effects of immunology in a gasless laparoscopic procedure were not different from those in a gas laparoscopic procedure. Rather, immediate preservation of the immune function during the postoperative period was detected in both groups.
Allergy and Immunology ; Bacteriophages ; Cholecystectomy ; Cytokines ; Humans ; Hydrocortisone ; Interleukin-6 ; Interleukin-8 ; Laparoscopy* ; Leukocyte Count ; Macrophages, Peritoneal ; Postoperative Period ; Tumor Necrosis Factor-alpha

Situs inversus, a left-to-right transposition of the normally asymmetrical organs of the body, is a rare anomaly that occurs in 1:5,000-1:10,000 adults. In the total form, the thoracic organs, as well as the abdominal organs, are completely reversed in a "mirror image" of their normal arrangement. Herein, we present a case of an adenocarcinoma of the proximal bile duct in a 68-year-old man with total situs inversus. Without any technical problems, he successfully underwent a bile-duct resection and bilioenteric anastomosis. He did well postoperatively, and after one course of chemotherapy, was discharged on postoperative day 12. A review of the international literature on this subject is presented.
Adenocarcinoma ; Adult ; Aged ; Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Drug Therapy ; Humans ; Situs Inversus*

No abstract available.
Cystadenoma, Mucinous* ; Mucins* ; Pancreas*

PURPOSE: Anal diseases are a common complication among patients with leukemia, and the perianal abscess may prove to be the most fatal among anal diseases. We report here the prevalence, the treatment methods, and the prognosis for anal diseases among patients with leukemia. METHODS: Among the 310 patients who were diagnosed with and treated for leukemia between October 1999 and September 2000, we investigated the medical records of 53 patients with complications due to anal diseases. RESULTS: Among the 310 patients with leukemia, 53 (17.1%) reported anal diseases. There were 30 patients with hemorrhoids, 15 patients with a perianal abscess, 3 patients with an anal fistula, 3 patients with a fissure and 2 patients with hemorrhoids and fistulas. Anal pain was the most common complaint. Conservative treatment improved the symptoms in 42 patients (79.2%) while surgery was necessary in the remaining 11 patients (20.8%). A hemorrhoidectomy was undertaken in 4 patients, a drainage procedure in 4 paients, and a fistulotomy in 3 patients. Throughout the study period, 6 patients died (11.3%), 3 of them with perianal abscesses. Among the 15 patients with a perianal abscess, 13 showed fever (87%), and 9 patients underwent drainage (4 surgical drainages and 5 natural drainages). E. coli was the most commonly cultured organism. CONCLUSIONS: The incidence of anal diseases in patients with leukemia was high. Nonsurgical methods were sufficient for hemorrhoids and fistulas. For a perianal abscess, drainage should be undertaken when abscess formation is evident. When abscess formation is not evident, medical treatment is the primary modality, and surgery should be considered only when medical treatment fails to improve or worsens the patient's condition, but the prognosis is poor.
Abscess ; Drainage ; Fever ; Fistula ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Incidence ; Leukemia* ; Medical Records ; Prevalence ; Prognosis ; Rectal Fistula

PURPOSE: Laparoscopic management of intestinal obstruction is hypothetically attractive, However little is known about this procedure in our country. With new advances in diagnostic and therapeutic tools such as laparoscopic procedures, the management of intestinal obstruction has become feasible. METHODS: In order to analyze the clinical results of laparoscopic adhesiolysis, a retrospective review of a consecutive series of 20 cases of intestinal obstruction unresponsive to medical management was done between 1997 and 2000. RESULTS: The mean surgical time for the laparoscopic procedure was 75 min and two cases were converted to open surgery due to dense adhesion and intestinal strangulation. The characterization of adhesion type included 10 cases with simple fibrotic band, 4 cases with multiple fibrotic band and 5 cases with dense adhesion. Additionally, the most common site for adhesion was the small intestine and colon (12 cases). The mean diet start time was 2.3 days, mean hospital stay was 4.7 days and totally mean analgesic use was 1.6 times. CONCLUSION: Laparoscopic management of adhesive bowel obstruction is feasible and safe in experienced hands. The laparoscopic procedure also is an excellent diagnostic modality in case of obstruction, and the majority of these cases can be simultaneously managed laparoscopically. A laparoscopic approach is recommend as a first choice of treatment for selective cases of intestinal adhesion.
Adhesives ; Colon ; Diet ; Hand ; Intestinal Obstruction ; Intestine, Small ; Length of Stay ; Operative Time ; Retrospective Studies

Presentation of antigen in a suitable form to lymphocytes is prerequsite for the initiation of primary immune response. Dendritic cells (DC) provide an effective pathway for presenting antigens to lymphocytes in situ. The aim of this study was to establish a dendritic cell-line from human tonsils and to investigate the changes in surface phenotype during culture. Immunohistochemical studies using various surface markers indicated that cultured DC were follicular dendritic cells (FDC) from human tonsils. Cultured DC showed typical dendritic morphology at early stage of culture. Their shape changed into fibroblast-like cells over culture time. Surface phenotype study suggested that cultured DC were distinct from human fibroblast. Antigenic pattern of FDC was changed during culture; I-ILA-DR antigens decreased and HJ2 antigens increased with aging of culture. Functional characteristics of human tosillar FDC will be investigated in the future.
Aging ; Dendritic Cells ; Dendritic Cells, Follicular* ; Fibroblasts ; Humans ; Lymphocytes ; Palatine Tonsil ; Phenotype

Diagnosing pseudoaneurysms of the popliteal artery is usually straightforward in physical examinations and imaging findings. However, when a pseudoaneurysm shows a soft tissue mass with adjacent osseous change, it can mimic a bone tumor or a soft tissue sarcoma. We present a case of a 65-year-old man who had a pseudoaneurysm of the popliteal artery showing soft tissue mass and insinuating into the intramedullary cavity of the tibia. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis of an apparent soft tissue mass with pressure erosion in adjacent bone.
Aged ; Aneurysm, False ; Diagnosis, Differential ; Humans ; Hydrazines ; Physical Examination ; Popliteal Artery ; Sarcoma ; Tibia

A spigelian hernia is a rare hernia of the lateral wall and is difficult to diagnose and localize before surgical exploration. We report the case of a spigelian hernia treated by using laparoscopy. The laparoscopic approach affords an accurate appraisal of the defect and a direct means of repair. More extensive use of laparoscopy, instead of open exploratory surgery, is recommended for the evaluation and repair of such hernias.
Hernia* ; Laparoscopy

PURPOSE:The lesion of Congenital Lipoid Adrenal Hyperplasia has been suggested to be in the 1st step of steroidogenesis of conversion of cholesterol to pregnenolone by P450scc. In 1995, however, the molecular defect of this disease has been located in the transport of cholesterol into mitochondria due to defective regulatory protein called Steroidogenic Acute Regulatory Protein(StAR), while the enzyme P450scc itself is normal. This genetic study using automatic sequence analyzer aimed at elucidating the molecular defect in the StAR gene of the two patients. METHODS:This study was performed on the two patients of Congenital Lipoid Adrenal Hyperplasia. Both children were phenotypically females. However, one turned out to have a karyotype of 46, XY, the other 46, XX. Genomic DNAs were extracted from their peripheral blood. We amplified the last exon, hot spot, of the StAR gene using 1 set of primer, S4, 5'-CCT GGC AGC CTG TTT GTG ATA G-3' AS4, 5'-CCT CAT GTC ATA GCT AAT CAG TG-3'. Subsequently, one PCR product have been directly sequenced by dideoxy termination method, and also the other products(patient's and her father's) have been sequenced by automatic sequence analyzer. RESULTS:The mutation was identified in the last exon of the StAR gene, substituting T for A at codon 258, replacing glutamine by stop codon in the two unrelated Korean patients with congenital lipoid adrenal hyperplasia. One patient were found to be homozygote, but the other to be heterozygote for the mutation. CONCLUSIONS:These results indicate that Korean children with congenital lipoid adrenal hyperplasia may be genetically identical as in Japanese. But, we discovered that the hot spot, codon 258, are not always homozygote. We want to emphasize the different point, and to say that we did experiece the automatic sequence analyzer successfully.
Animals ; Asian Continental Ancestry Group ; Cats ; Child ; Cholesterol ; Codon ; Codon, Terminator ; DNA ; Exons ; Female ; Glutamine ; Heterozygote ; Homozygote ; Humans ; Hyperplasia ; Karyotype ; Mitochondria ; Molecular Biology* ; Polymerase Chain Reaction ; Pregnenolone